Feeling blue, going green and finding other attractive alternatives: a case of biphasic anaphylaxis to patent blue and a literature review of alternative sentinel node localisation methods

Abstract

Patent blue dye is used for sentinel lymph node localisation in order to stage the axilla in patients with breast cancer. Patent blue is one of the most common dyes used across the UK, however, the incidence of adverse effects seems to be increasing. This case highlights our experience of a biphasic anaphylactic reaction to patent blue dye, and we conduct a brief literature review of alternative and more novel methods to adequately visualise the lymphatics for sentinel lymph node biopsy.

A case of immediate hypersensitivity reaction after an oral administration of patent blue dye

“…This delay is slightly longer in the case of intradermal injection, ranging from 15 to 45 min . Furthermore, the possibility of a secondary late‐phase reaction to blue dye, if the initial administration resulted in a severe reaction, should be considered …”

“…11 Furthermore, the possibility of a secondary late-phase reaction to blue dye, if the initial administration resulted in a severe reaction, should be considered. 2 The mechanisms of immediate hypersensitivity to PBV are still…”

“…Hypersensitivity to this dye has been mainly described during sentinel lymph node procedures in patients with cancer . Hypersensitivity reactions include urticaria, “blue hives,” pruritus or generalized rash, extracutaneous lesions such as angioedema, bronchospasm, or cardiovascular symptoms . These are usually triggered after intravenous or subcutaneous exposure to PBV .…”

Adverse reactions during procedures

“…10 When patent blue or isosulfan blue is the elicitor of IHR, urticaria may occur as pathognomonic blue-green hives. 11 Extravasation of dye, which also causes blue-green skin discoloration but no other symptoms such as wheals, must be considered as a differential diagnosis. 12 Biphasic reactions have been reported in IHR to patent blue.…”

“…12 Biphasic reactions have been reported in IHR to patent blue. 11 Physicians should be aware of this pattern and carefully monitor the patient after initial treatment for occurrence of a second reaction.…”